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Abstract
Background/AimsWe assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes.MethodsConsecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defined as a focal thickening >1.3 mm.ResultsPrevalence of high OSA risk was similar in patients refusing or accepting PG (76% vs 68%, p = 0.17). Among those accepting PG, overall OSA prevalence was significantly higher in patients with F2-F4 fibrosis compared to those without (72% vs 44%; p = 0.04). Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)<95% (OR 3.21, 95%C.I. 1.02–7.34; p = 0.04). Prevalence of OSA tended to be higher in patients with, than in those without, carotid plaques (64% vs 40%; p = 0.08). Carotid plaques were independently associated with %time at SaO2<90% >1 (OR 6.30, 95%C.I. 1.02–12.3; p = 0.01).ConclusionsIn NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, OSA was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis. These data suggest to consider sleep disordered breathing as a potential additional therapeutic target in severe NAFLD patients.
Highlights
In a short time, the current epidemic of overweight and obesity may lead to an increase in prevalence of non-alcoholic fatty liver disease (NAFLD), a major cause of chronic liver disease worldwide [1,2,3]
Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)
In NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, obstructive sleep apnea (OSA) was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis
Summary
The current epidemic of overweight and obesity may lead to an increase in prevalence of non-alcoholic fatty liver disease (NAFLD), a major cause of chronic liver disease worldwide [1,2,3]. A considerable proportion of patients with NAFLD is at risk of progression to cirrhosis [2,4], and development of cancer and cardiovascular events [5]. The pathogenesis of NAFLD is multifaceted and incompletely understood. In this complex landscape, a number of metabolic factors like obesity, insulin resistance (IR) and diabetes [6,7,8] have been identified as involved in the pathogenesis and progression of liver fibrosis. The same factors have been confirmed as predictors of cardiovascular events among patients with NAFLD. New actors in the pathogenesis of liver and cardiovascular damage in NAFLD are emerging, such as genetic background [9], fructose consumption [10], hyperuricemia [11], and vitamin D deficiency [12]
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